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“Stress Control” as a Large Group Psychoeducational Intervention at Step 2 of IAPT Services: Acceptability of the Approach and Moderators of Effectiveness

  • Paul Burns (a1), Stephen Kellett (a2) and Gill Donohoe (a3)


Background: “Stress Control” (SC) has been adopted as a core intervention in step 2 of Improving Access to Psychological Therapies (IAPT) services, but contemporary evidence of effectiveness has lagged behind service uptake. Aims: To investigate the acceptability and effectiveness of SC and to explore moderators of outcome. Method: Analysis of acceptability (via attendance rates) and effectiveness (via IAPT minimum dataset). Results: SC was well tolerated with 73.3% of all patients and 75.4% of “clinical cases” attending three or more sessions. Of the 546 “clinical cases” attending SC and not in receipt of other interventions, 37% moved to recovery. Attendance improved outcome; for those patients attending all SC sessions the recovery rate rose to 59.2%. Conclusion: SC appears a well-tolerated and effective intervention that enables large numbers to gain access to treatment in an organizationally efficient manner. Attendance is important in facilitating SC outcomes and research evaluating attendance interventions are needed.


Corresponding author

Reprint requests to Stephen Kellett, Consultant Clinical Psychologist, Clinical Psychology Unit, University of Sheffield, Sheffield S10 5FY, UK. E-mail:


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Ali, S., Littlewood, E., McMillan, D., Delgadillo, J., Miranda, A., Croudace, T., et al. (2014). Heterogeneity in patient-reported outcomes following low-intensity mental health interventions: a multilevel analysis. PloS ONE, 9, e99658.
Brown, J., Elliott, S. A. and Butler, C. (2006). Can large-scale self-referral psychoeducational stress workshops help improve the psychological health of the population? Behavioural and Cognitive Psychotherapy, 34, 165177.
Clark, D.M. (2011). Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: the IAPT experience. International Review of Psychiatry, 23, 375384.
Clark, D.M., Layard, R., Smithies, R., Richards, D.A., Suckling, R. and Wright, B. (2009). Improving access to psychological therapy: initial evaluation of two UK demonstration sites. Behaviour Research and Therapy, 47, 910920.
CSIP Choice and Access Team (2008). Improving Access to Psychological Therapies (IAPT) Commissioning Toolkit. London: Department of Health.
Department of Communities and Local Government (2011a). English IMD 2010 Data. Retrieved from:
Department of Communities and Local Government (2011b). English Indices of Deprivation 2010. Retrieved from:
Evans, C., Margison, F. and Barkham, M. (1998). The contribution of reliable and clinically significant change methods to evidenced-based mental health. Evidenced Based Mental Health, 1, 7072.
Firth, N., Barkham, M. and Kellett, S. (2014). The clinical effectiveness of stepped care systems for depression in working age adults: a systematic review. Journal of Affective Disorders, 170, 119130.
Firth, N., Barkham, M., Kellett, S. and Saxon, D. (2015). Therapist effects and moderators of effectiveness and efficiency in psychological wellbeing practitioners: a multilevel modelling analysis. Behaviour Research and Therapy, 69, 5462.
Green, H., Barkham, M., Kellett, S. and Saxon, D. (2014). Therapist effects and IAPT psychological wellbeing practitioners (PWPs): a multilevel modelling and mixed methods analysis. Behaviour Research and Therapy, 63, 4354.
Gyani, A., Shafran, R., Layard, R. and Clark, D. M. (2013). Enhancing recovery rates: lessons from year one of IAPT. Behaviour Research and Therapy, 51, 597606.
Houghton, S. and Saxon, D. (2007). An evaluation of large group CBT psycho-education for anxiety disorders delivered in routine practice. Patient Education and Counselling, 68, 107110.
Joice, A. and Mercer, S. (2010). An evaluation of the impact of a large group psycho-educational programme (Stress Control) on patient outcome: does empathy make a difference? The Cognitive Behaviour Therapist, 3, 117.
Kellett, S., Newman, D. W., Matthews, L. and Swift, A. (2004). Increasing the effectiveness of large group format CBT via the application of practise-based evidence. Behavioural and Cognitive Psychotherapy, 32, 231234.
Kellett, S., Clarke, S. and Matthews, L. (2007a). Delivering group psychoeducational CBT in primary care: comparing outcomes with individual CBT and individual psychodynamic-interpersonal psychotherapy. British Journal of Clinical Psychology, 46, 211222.
Kellett, S., Clarke, S. and Matthews, L. (2007b). Session impact and outcome in group psycho-educative cognitive behavioural therapy. Behavioural and Cognitive Psychotherapy, 35, 335342.
Kroenke, K. and Spitzer, R. L. (2002). The PHQ-9: a new depression diagnostic and severity measure. Psychiatric Annals, 32, 509515.
Layard, R., Bell, S., Clark, D., Knapp, M., Meacher, M., Priebe, S., et al. (2006). The Depression Report: a new deal for depression and anxiety disorders. London School of Economics and Politic Science: Centre for Economic Performance's Mental Health Policy Group.
Lukens, E. P. and McFarlane, W. R. (2004). Psychoeducation as evidence-based practice: considerations for practice, research and policy. Brief Treatment and Crisis Intervention, 4, 205225.
Parry, G., Barkham, M., Brazier, J., Dent-Brown, K., Hardy, G., Kendrick, T., et al. (2011). An Evaluation of a New Service Model: Improving Access to Psychological Therapies demonstration sites 2006–2009. Final report. Southampton: NIHR Service Delivery and Organization Programme.
Spitzer, R. L., Kroenke, K., Williams, J. B. W. and Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder. Archives of Internal Medicine, 166, 10921097.
Stean, H.S. (2014). Resolving Counterresistances in Psychotherapy. Philadelphia: Brunner/Mazel.
Turpin, G. (2010). IAPT Good Practice Guide to using Self-help Materials. NMHDU/IAPT, 1–40.
Turpin, G., Richards, D., Hope, R. and Duffy, R. (2008). Improving access to psychological therapies: a national initiative to ensure the delivery of high quality evidence-based therapies. Papeles del Psicologo, 29, 271280.
Van Deale, T. (2013). A Psychoeducational Approach to Stress Management: an implementation and effectiveness study (unpublished Ph.D. dissertation). University of Leuven, Belgium. Retrieved from
White, J. (1995). An analysis of components in large group didactic therapy: “Stress Control”. Clinical Psychology Forum, 76, 1113.
White, J. (1998). “Stress Control” large group therapy for generalized anxiety disorder: two year follow-up. Behavioural and Cognitive Psychotherapy, 26, 237245.
White, J. (2000). Treating Anxiety and Stress: a psychoeducational approach in groups using brief cognitive behaviour therapy. Chichester: Wiley.
White, J. (2008). CBT and the challenge of primary care: developing effective, efficient, equitable, acceptable and accessible services for common mental health problems. Journal of Public Mental Health, 7, 3241.
White, J. and Keenan, M. (1990). “Stress Control”: a pilot study of large group therapy for generalized anxiety disorder. Behavioural Psychotherapy, 18, 143146.
White, J., Keenan, M. and Brooks, N. (1995). “Stress Control”: a controlled comparative investigation of large group therapy for generalized anxiety disorder. Behavioural Psychotherapy, 20, 97114.
White, J. and Keenan-Ross, M. (1997). Stress Control large group didactic therapy for anxiety: an approach for managed care systems. The Behavior Therapist, 20, 192196.
Wood, S., Kitchiner, N. J. and Bisson, J. I. (2005). Experiencing and implementing an adult educational approach to treating anxiety disorder. Journal of Psychiatric and Mental Health Nursing, 12, 9599.



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“Stress Control” as a Large Group Psychoeducational Intervention at Step 2 of IAPT Services: Acceptability of the Approach and Moderators of Effectiveness

  • Paul Burns (a1), Stephen Kellett (a2) and Gill Donohoe (a3)
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